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BACKGROUND: Open reduction and internal fixation represent prevalent orthopedic procedures, sparking ongoing discourse over whether to retain or remove asymptomatic implants. Achieving consensus on this matter is paramount for orthopedic surgeons. This study aims to quantify the impact of routine implant removal on patients and healthcare facilities. A retrospective analysis of implant removal cases from 2016 to 2022 at King Fahad Hospital of the University (KFHU) was conducted and subjected to statistical scrutiny. Among these cases, 44% necessitated hospitalization exceeding one day, while 56% required only a single day. Adults exhibited a 55% need for extended hospital stays, contrasting with 22.8% among the pediatric cohort. The complication rate was 6%, with all patients experiencing at least one complication. Notably, 34.1% required sick leave and 4.8% exceeded 14 d. General anesthesia was predominant (88%). Routine implant removal introduces unwarranted complications, particularly in adults, potentially prolonging hospitalization. This procedure strains hospital resources, tying up the operating room that could otherwise accommodate critical surgeries. Clearly defined institutional guidelines are imperative to regulate this practice. AIM: To measure the burden of routine implant removal on the patients and hospital. METHODS: This is a retrospective analysis study of 167 routine implant removal cases treated at KFHU, a tertiary hospital in Saudi Arabia. Data were collected in the orthopedic department at KFHU from February 2016 to August 2022, which includes routine asymptomatic implant removal cases across all age categories. Nonroutine indications such as infection, pain, implant failure, malunion, nonunion, restricted range of motion, and prominent hardware were excluded. Patients who had external fixators removed or joints replaced were also excluded. RESULTS: Between February 2016 and August 2022, 360 implants were retrieved; however, only 167 of those who met the inclusion criteria were included in this study. The remaining implants were rejected due to exclusion criteria. Among the cases, 44% required more than one day in the hospital, whereas 56% required only one day. 55% of adults required more than one day of hospitalization, while 22.8% of pediatric patients required more than one day of inpatient care. The complication rate was 6%, with each patient experiencing at least one complication. Sick leave was required in 34.1% of cases, with 4.8% requiring more than 14 d. The most common type of anesthesia used in the surgeries was general anesthesia (88%), and the mean (SD) surgery duration was 77.1 (54.7) min. CONCLUSION: Routine implant removal causes unnecessary complications, prolongs hospital stays, depletes resources and monopolizing operating rooms that could serve more critical procedures.
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Background: The association between COVID-19 and acute cerebrovascular disease (CVD) has not been explored extensively. New data has come to light which may change previous results. Methods: We queried the PubMed electronic database from its inception until February 2022 for studies evaluating the incidence of stroke in COVID-19 patients. Results of the analysis were pooled using a random-effects model and presented as odds ratios (ORs) with 95% confidence intervals (95% CIs). Results: 37 studies consisting of 294,249 patients were included in our analysis. Pooled results show that the incidence of acute CVD events in COVID-19 positive patients is 2.6% (95% CI: 2.0-3.3; P<0.001). Cardioembolic (OR=14.15, 95% CI: 11.01 to 18.19, P<0.00001) and cryptogenic (OR=2.87, 95% CI: 1.91 to 4.32, P<0.00001) etiologies were associated with COVID-19 positivity. Risk factors for CVD events in patients with COVID-19 were atrial fibrillation (OR=2.60, 95% CI: 1.15 to 5.87, P=0.02), coronary artery disease (OR=2.24, 95% CI: 1.38 to 3.61, P=0.0010), diabetes (OR=2.46, 95% CI: 1.36 to 4.44, P=0.003) and hypertension (OR=3.65, 95% CI: 1.69 to 7.90, P=0.005). Conclusion: COVID-19 infection is associated with an increased risk for acute CVD and is associated with cardioembolic and cryptogenic etiologies and the risk factors of atrial fibrillation, coronary artery disease, diabetes and hypertension in COVID-19 positive patients.
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Aim: We aim to evaluate the impacts of sodium-glucose co-transporter 2 inhibitors (SGLT-2), glucagon-like peptide 1 agonist (GLP-1RAs), and dipeptidyl peptidase-four (DPP4) inhibitors on the levels of high-density lipoprotein, low-density lipoprotein, triglyceride and total cholesterol. Methods: The MEDLINE database was searched from inception till October 2021, for randomized controlled trials assessing the effects of sodium-glucose co-transporter two inhibitors (SGLT-2), glucagon-like peptide 1 agonist (GLP-1RAs), and dipeptidyl peptidase-four (DPP4) inhibitors on lipid levels. Results: A total of 57 trials were included in the analysis. Our pooled analysis demonstrates that SGLT-2 inhibitors significantly increase the levels of HDL (WMD = 0.07 mg/dL [0.06 to 0.08], P < 0.00001). SGLT-2 inhibitors were also found to be significantly associated with an increase in the levels of LDL (WMD = 0.11 mg/dL, [0.09-0.13 mg/dL, P < 0.00001). Pooled analysis also demonstrates that SGLT-2 inhibitors significantly reduce the levels of triglyceride (WMD = -0.10 mg/dL, [-0.13 to -0.06], P < 0.00001). Our pooled analysis demonstrates that SGLT-2 inhibitors significantly increased the levels of total cholesterol (WMD = 0.10 mg/dL, [0.06 to 0.15], P < 0.0001), whereas, GLP-1RAs significantly reduced the levels of total cholestrol (WMD = -0.18 mg/dL, [-0.34 to -0.02], P = 0.03). Conclusion: This is the first head-to-head study comparing the effects of 3-novel glucose-lowering agents to lipid parameters. However, more trials are crucial to better understand the impact of glucose-lowering drugs on lipid parameters.
